| NPI | 1558835777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11028363) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: FL 11028363) |
| Enumeration Date | 2019-01-22 |
| Last Update Date | 2026-08-20 |